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Clinical Review Coordinator in Harrisburg, PA at KEPRO

Date Posted: 8/5/2018

Job Snapshot

Job Description

Since 1985, KEPRO has helped more than 20 million members lead healthier lives through clinical expertise, integrity and compassion. KEPRO was founded by physicians and clinical expertise is at the core of our organization. We are a leading quality improvement and care management organization. We offer innovative and outcomes-focused solutions to reduce the unnecessary use of health care resources and optimize the quality of care for public and commercial clients. KEPRO’s tailored programs maximize members’ quality of life, and realize greater cost savings for members and clients alike. KEPRO is on a journey to transform medical management and to develop customized solutions tailored to our client’s specific business requirements, while improving the quality of life for patients, reducing costs, and achieving return on investments for our clients. Our approach to medical management is holistic and compassionate and is coordinated around a patient’s entire healthcare experience.

Clinical Review Coordinator

Summary Description

Responsibilities include medical record review, preparing cases for physician review and related activities for all cases selected on a timely, accurate and efficient basis. This position does not have the ability to work from home.

Accountabilities

  • Perform required non-physician review activities within specified timeframes and within the guidelines of the QIO manual.
  • Communicate (verbally and/or writing) with external customers to furnish information pertaining to the review process and results.
  • Foster effective working relationships between KEPRO’s internal and external customers.
  • Utilize case management/mediation methodologies for appropriate types of reviews.
  • Assist with and participate in the Review Team in identifying areas for potential improvement as noted on case reviews.
  • Utilize internal quality control tools to assess individual work and team processes.
  • Enter all relevant data into SDPS system; maintain timely data entry throughout entire case review.
  • Perform other duties as assigned.

The list of accountabilities is not intended to be all-inclusive and may be expanded to include other education- and experience-related duties that management may deem necessary from time to time.

Qualifications

  • RN

Skills, Knowledge Abilities         

  • Ability to review medical records objectively, completely and timely.
  • Excellent verbal communication skills, courteous and patient demeanor.
  • Must be customer oriented and have the ability to maintain composure under potentially stressful situations.
  • Good grammar, punctuation, spelling, hyphenation and written communication skills.
  • Customer focused, results oriented and capable of building and maintaining relationships with internal and external customers.
  • Must be flexible and able to work as a team member and support team decisions.
  • General knowledge of a PC based computer system required
  • Knowledge of various software packages with ability to learn additional software applications as needed.
  • Must multi-task and prioritize assignments.
  • Must have good organizational skills and work independently.

Experience        

  • Recent nursing experience.
  • UR experience very helpful.
  • Training in continuous quality improvement approaches and methods a plus.

 

Mental and Physical Requirements        

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.  Reasonable accommodations will be made as required by law in an attempt to enable an individual with a disability to perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to sit for prolonged periods of time; key and/or control objects; interact extensively with internal and external customers; occasionally lift and/or move objects weighing up to 10 pounds.

Only those candidates identified for an interview will be contacted. No Phone Calls Please.  Visit our website at www.kepro.com for more information on the KEPRO Family of Companies

EOE AA M/F/Vet/Disability

KEPRO is an E-Verify employer. E-Verify is an internet based system operated by the Department of Homeland Security (DHS) in partnership with the Social Security Administration (SSA) that allows participating employers to electronically verify the employment eligibility of their newly hired employees in the United States.

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